Home Births

I was somewhat dismayed to see that there has been a significant increase in women having home births here in the US. Before I continue, let me first say that I have never been pregnant or had a child, nor am an expert in pregnancy and birth matters (perhaps some readers know more about it? Any OBGYNs out there?). However, it seems to me this increase in home birth is potentially harmful. Sure, plenty of babies are born at home and are perfectly fine. But what if there are complications? Shouldn’t babies be born in hospitals where potentially lifesaving care– for both baby and mother– is only seconds away? Doesn’t hospital birth seem like a good thing?

I can understand why many mothers are not inclined to give birth in hospitals. Hospitals are sterile, artificial environments that at best feel like a tacky, too-clean hotel room and at worst feel like a crowded bus station waiting room. I’ve spent a fair amount of time in hospitals– primarily when my mom and a couple of friends had health problems– and even the nicest, cleanest, quietest hospitals are still fairly miserable places. Hospitals are places where people are sick, often dying, and that’s no fun. Some hospitals have wonderful birthing centers with private rooms, but other hospitals do not provide such luxurious accommodation. Sometimes you might not even have your own room when you give birth. I can see why many mothers find giving birth in their own home, surrounded by only family and friends and maybe a midwife, an attractive idea. Home is probably much nicer than a hospital. But… a hospital has doctors, nurses, and medical equipment that could save your life and the life of your newborn.

Personally, while I find hospitals miserable at times, I also find hospitals very interesting. Hospitals are places where remarkable, modern medicine takes place and many lives are saved and improved. I enjoy talking to doctors and nurses about the care they are providing. As stressful as it is to see a friend or relative sick, I also find my scientific mind is curious about all of the procedures and the care that is being provided. Hospitals remind me of a laboratory environment, and that tends to put me more at ease in hospitals. Labs have science, and I like science. Modern medicine is based on science. Science is good.

Personally, if I ever give birth I want to be in a hospital… hopefully a good one. I joke with my fiance that I want the least natural childbirth ever. Seriously. Screw natural childbirth. I want the maximum safe dose of painkillers, and I want doctors to be seconds away in case anything goes wrong with the birth. I want to take advantage of modern medicine because, really, why not? I mean, when I had an infection I didn’t say to my doctor, “Oh, no. Antibiotics aren’t natural, so I don’t want them.” and when I had an operation on my leg I didn’t say, “Oh, no. Anesthesia isn’t natural. Do you have any big men who can hold me down?” and when I was a kid my mom (thank FSM) didn’t say to my pediatrician, “Oh, no. Vaccines aren’t natural, so I’d prefer my kid got measles.” So, there’s no way I’m going to say, “Oh, no. A hospital birth isn’t natural. I’d prefer to give birth in the backyard birthing shack with a stick in my mouth.”

If I could be knocked out and wake up with a beautiful baby in my arms, that would be ideal. I’m sure that some baby-loving hormones will kick in and such when I actually have to give birth, but right now I find the idea of giving birth absolutely terrifying. Come to think of it, pregnancy is terrifying too. I mean, a parasite grows in you for nine months and then explodes out of you… isn’t that like one of those alien movies? If modern medicine can help mitigate my pregnancy/birthing fears and keep me an my baby safe, I’m all for it.

Don’t get me wrong– I’m not saying that there aren’t potential problems with hospital births. In the US, for instance, there is debate about why the rate of Caesarean section is so high. But I still think hospital births are wiser than home births. Personally, what I plan to do if I become pregnant is to talk in detail with my doctor (maybe more than one doctor) and make calm, rational decisions about what I do and do not want for my birth. I want to make those decisions before I’m at the hospital and my poor husband’s hand is being crushed as I scream at him, “You bastard! This is your fault!” One thing I know for sure, though– if I ever have kids, my birth(s) will definitely be in a hospital. And I’d like some drugs, please.

Any thoughts on the natural/unnatural childbirth debate?

Update: I highly recommend reading this article by Harriet Hall on Home Birth Safety.

Evelyn is a geologist, writer, traveler, and skeptic residing in Cape Town, South Africa with frequent trips back to the US for work. She has two adorable cats; enjoys hiking, rock climbing, and kayaking; and has a very large rock collection. You can follow her on twitter @GeoEvelyn. She also writes a geology blog called Georneys.

63 Comments

By the way, I really do love children, babies included. I may refer to my child as a parasite while growing, but I will do so very, very lovingly.

Also, I think this post was inspired partly by the visit of a little baby today (a colleague and his wife brought their young daughter by work for a visit). When I looked at the beautiful little baby girl, my biological clock went DING DING DING YOU MUST HAVE ONE.

I managed to stop the ringing by telling my biological clock that I must first finish taking care of my PhD thesis child.

I had a $300 copay for my Cesarean, but I think the full cost was around $10,000, though I don’t think I saw every statement from the hospital. They itemize the costs and send separate bills, so it’s hard to tell. I didn’t have any copays for my prenatal care, including ultrasounds and lab tests. It all depends on what type of health insurance you have (if you have it).

For comparison, a friend of mine is having a homebirth and her midwife is charging her $3500 for the whole thing, including prenatal care. She won’t buy health insurance, so if she ends up needing to transfer to hospital, she’s screwed.

I have yet to have any desired to have children and sincerely hope that this condition is permanent. :)

That said, I disagree with the perspective in this article that hospital births are the only reasonable choice and if I had a choice and everything was low risk, I would chose a home birth in the presence of a professional midwife (something that I have heard is illegal in some US States).

There is an interesting discussion about a recent paper on the risk of home births in the Netherlands, where 30% of births are at home. Netherlands home birth study discussion Essentially, in a country where midwifery is a well supported and respected profession that is fully integrated into the medical system, there is no significant affect of birthing location (home or hospital) on infant mortality.

Ihe problem with hospital environments occurs when procedures are conducted without the consent of the woman giving birth. I have a rather large problem with this. Regardless of whether it is necessary or not, it should be the woman’s choice and she should have the confidence that the staff will work in her best interests. I am not convinced (and have heard from female work colleagues who have given birth in the US that they have not always been happy at the decisions made – but this is anecdotal and not data) that the woman’s rights are at the forefront of the hospital birth system in the USA.

I think the wisest thing is to know what you want, be fully informed of all the risks and make the choice right for you. If circumstances change, you need to be aware of the consequences of any decision you make, be flexible, and preferably come up with worst case senario plans. this is probably wise to do whether you chose a home or a hospital birth.

What you said about non-consent. They were going to pop my water for no reason. No reason at all. I was doing just fine, and didn’t need it. You know what happens when the water pops? It increases risk of infection. Know what happens when it doesn’t pop? Nothing. Doesn’t even get in the way (the baby’s head will pop the water while exiting the womb if it comes to that). I had to stop her at the last minute and ask her why she was about to probe my vagina with a pointy stick. SHE DIDN’T EVEN TELL ME WHAT SHE WAS ABOUT TO DO, she was just going for it! I understand some things are necessary to save a life. But if I’m awake and right there in the room, don’t act like I’m not there, especially when it’s my body you’re messing with.

There’s plenty of horror stories like TheNerd’s, but generally when something is done without the woman’s consent it’s because there isn’t time to ask and explain the choices to her (because it’s not really consent unless it’s informed). Childbirth is horrible business and a matter of seconds can mean the difference between a life baby and a dead one, or even just an injured baby or a healthy one.

I’m not quite sure where to start with this post. First of all, I think it’s kind of ridiculous to open a piece noting the fact that you haven’t looked into birth in any serious manner before and then continuing to lecture on why people that do research and come to a certain conclusion are putting themselves and their babies at risk. I know I’ve made comments on another post having to do with the idea of hospital births being the only reasonable choice, and I don’t want to come across as some crazy birth vigilante, but all I’ve seen from any skepchicks regarding birth issues in the US boils down to: “I just feel like this way is best and the other way is dangerous. But don’t ask me to back anything up with facts or anything.”

IT SEEMS LIKE THE ANTITHESIS OF SKEPTICISM.

I think one of the most interesting books that I read regarding childbirth was “Born In the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First” by Marsden Wagner. Wagner is the former director of Women’s and Children’s Health at the WHO, and he has some highly relevant insight. There are also some good books that are extremely thoroughly researched by Henci Goer.

All of this is not to say that I think that it is a bad thing for anyone to decide on a hospital birth. I also, however, know that the research shows homebirth with a trained nurse-midwife to be a safe alternative. Undoubtedly dangerous C-section rates all over America are real. Unnecessary (FOR LOW-RISK LABORING WOMEN) interventions are not only linked to the increased C-section rate, but are also extremely prevalent in hospitals today. (To use a personal example: when I was transferred to the hospital during birth after a couple hours the OBs decided that they wanted to break my water. About an hour after they broke my water they CAME BACK IN TO SAY THAT THEY NEEDED TO INCREASE THE WATER BECAUSE BREAKING THE WATER WASN’T SITTING WELL WITH MY BABY.) Nosocomial infections are very real.

And one more thing that seems to really be present in Skepchicks’ criticism of the homebirth/birth center trend: THE HOSPITAL ROOM NOT LOOKING PRETTY ENOUGH NEVER FACTORED INTO WHERE I WANTED TO GIVE BIRTH. I’m sorry, but I think that it is the most ridiculous assumption that people want to give birth outside of a hospital because “hospitals are a real downer, man.”

Thanks for your reply and the book suggestions. I would really like it if people would direct me to some useful references and statistics on this subject matter. I don’t mean for this post to be flippant (sorry if it is)– I actually really want to learn more about this. Please do continue to post articles, books, facts, etc. I’m not an expert on the matter, but I’d like to become one… especially before I consider having children.

I don’t think hospital birth is perfect, just what I would be most comfortable with and what I (personally) consider to be safest.

And that’s basically what I am an advocate of, is women becoming really informed. Because if you read books with very credible sources, and do the research for yourself, then you can make a decision that you feel really comfortable with. And that is a very good start to having a good birth outcome. I’m sorry if I came off as abrasive. Happy reading!

belouise, I have to say that calling out the straw man of “pretty hospital rooms” is awesome. One thing I always hear is that home birthing women want candles and whalesongs, haha. Women make these choices every day, and it’s been very much my experience that discounting the factors that go into their reasoning is incredibly common, a result of our sexist culture, I’d argue. This goes both ways, though; home birthing women want candles and whalesongs, and hospital birthing women have been brainwashed by doctors. Natural birthers are dismissed as “wanting to prove something”, and women who choose c-sections are “lazy and too posh to push”.

All I really want for women giving birth is that they be informed, have the support they need before, during and after birth, and that they make the choices that are right for them. Is that so much to ask??

One of the things that is remarkable about homebirth advocates is that they make up bald faced lies and present them as facts.

The claim that I was forced to resign for Science Based Medicine is yet another bald-faced lie, made up, like most homebirth lies, purely because it appealed.

I don’t care if people want to rail at me, call me names or insist that no one should listen to me (much more satisfying for homebirth advocates than trying to dispute what I write) but I draw the line at lies.

I’m actually a doula- that is, I attend women in labor and birth professionally, providing emotional and physical support. This is my full-time job and I love it. I just had to reply to this.

Childbirth is a completely normal bodily function, like having a bowel movement. I’m not saying it’s not painless, not in the least, but it’s not always painful, and for women who choose natural birth, the pain is frequently overshadowed by the excitement and anticipation. Epidurals are definitely a wonderful tool to have in our toolbox, but modern medicine can’t mitigate your fears; only a culture of women who have been through natural birth and openly share their positive experiences can do that.

My mother was a doctor for many years, and the way I became a doula was that when I was planning my wedding, she kept dropping “hints” about getting on the baby train by sending me books about natural birth. I’ll read anything you give me, and when I found myself looking up information about issues that would never apply to me, such as teen pregnancy and Rhogam, I figured I should explore this further.

My mom knew that I was terrified of birth, just like you- given the choice between medication-free births and only having children by adoption, I would have gone for adoption! I imagined that when I learned I was pregnant, my happiness would be overshadowed by the sense that now I was on a long, long, slow rollercoaster ride, waiting to get to the top of the highest hill, when I would go into labor. What a terrible image!

Now that I’ve attended births, and learned all about the process that our bodies go through to deliver a child, I have no worries about birth whatsoever. Whether I’m in a hospital or at home, I know well that I’m likely to be just fine. I can’t say whether I would choose pain relief or not, but if I don’t, it won’t be because I’m rejecting modern medicine(or biting on a stick!).

People choose home birth for lots of reasons. In the main, the midwives who attend women at home vet their patients carefully; high-risk women are referred to their backing OBs or maternal-fetal specialists. By the time a woman reaches term, some of the problems that would cause trouble in birth have already been identified by sound prenatal care. Of the other reasons that a woman might need care that only a hospital could provide, most do not require precipitous transport to the hospital, or can be stabilized by the midwife safely until the hospital is reached. I am definitely not saying that home birth is safer than hospital birth, please note; it is a study in risk assessment, however, and for the vast majority of women is sufficiently safe, particularly when the midwife is skilled and educated. Certified Nurse-Midwives(CNMs) are the gold standard, with advanced degrees; while most practice in hospitals, many attend home births as well. The evidence is not particularly conclusive as to the risk, in any case, and some studies show that home birth with a skilled midwife is as safe as hospital birth for low-risk women.

I hope this gave you some food for thought. I am a feminist and a skeptic, as well, and I see my work as being essentially feminist, not just in supporting women in the only work that can be truly described as women’s work, but in helping women let go of their fear, embrace their body’s innate ability to push that sucker out, and make their choices without fear or second-guessing. It’s a beautiful, messy, amazing thing.

Oh, my, yes! Most doulas ONLY attend women who have hospital births, mostly because that is the vast majority of birthing women. I’m working right now to find a home birth midwife to work with, specifically because I’d love to observe a home birth.

The last birth I attended was one where the mom planned to have an epidural as early as possible. I helped her labor at home in the wee hours, and we headed into the hospital when she was about 3 cm, and she received her epidural shortly thereafter. I would also attend a planned C-section with no qualms; the very process of giving birth under any circumstances is a major event, and an experienced woman focused just on the mother’s comfort and well-being always goes over well.

Many hospitals also have midwives(CNMs) that practice there. I’d have to say that that situation may well be the best of both worlds. My biggest quibble with hospital birth, in two years of practice, is that the doctors are convinced that THEY’RE the ones doing all the work!

That is generally a pretty good combination. And some areas even have birth centers that are run by nurse-midwives, but they are close to a hospital and on good terms with the hospital staff, so that if you did have to transfer it would be quick and painless (haha I accidentally just typed “palinless”). The downside there is that you can’t have an epidural at a birth center, so if you definitely think that you would feel more comfortable with an epidural, a hospital would be the route to go!

I’m happy to help! The best thing in birth is realizing that there are feasible choices and that you’re the one in control of your body and your birth.

Honestly, there are a lot of woo-woo practices in the “alternative birth” world. This is a rich mine for those of us who like to dig the crazy out- note the “unassisted birth” folks, the homeopathic induction methods, the religious refusal of pain medications based on God’s decree that women should suffer during labor. Maybe it’s just me, I do have a talent for ferreting out the crazies.

Some books that you might find helpful: Ina May Gaskin’s Guide to Birth and Henci Goer’s Thinking Woman’s Guide to a Better Birth are both terrific books that are well worth reading, but they’re also pretty hippie and anti-hospital, so bring your grain of salt along. I’d say one of the best things you can do is hear other women’s stories and watch other women give birth, too: Youtube is great for that sometimes, and not others. One video I like, that is NOT safe for work, is this: http://www.youtube.com/watch?v=DI5-jx_vcp4 It’s not scary, but it is full to the brim of hippies- and their children are attending the birth too. More hippies, and happy birth stories can be found here: http://www.pregnancybirthandbabies.com/POSITIVE_birth_stories.htm This website is run by a woman who does hypnobirthing, so a lot of the stories reflect that.

But when you go traipsing about the Internet, let me just warn you that MotheringDotCom, or MDC, is famous for being full of people who think that if a doctor’s doing it, it ain’t no damn good. Other than that, though, they’ll swallow any fool thing!

@Evelyn – Look into your local hospital and what options are in your area. I gave birth in Ontario where midwives work in conjunction with certain hospitals and I won the birthing lottery. My hospital’s maternity ward was recently renovated so I had the privacy of my own room, and my midwives were there with my as my caregivers. It was just me, my husband, and our midwives and in no significant way different from birthing at home.

But when things started to go wrong, I didn’t have to worry about calling ambulances, rushing to the hospital, or anything like that. When things started going wrong, we had all the specialists we needed just down the hall.

If my choice were between a homebirth and one of those hospitals that bars midwives or makes you labour in a room full of other labouring women, I may not have made the same decision. But as it was, I couldn’t be happier with my hospital birth. So definitely look into your options.

“By the time a woman reaches term, some of the problems that would cause trouble in birth have already been identified by sound prenatal care. Of the other reasons that a woman might need care that only a hospital could provide, most do not require precipitous transport to the hospital, or can be stabilized by the midwife safely until the hospital is reached.”

It’d be awesome if that were always true. However, it wasn’t for me. I had a wonderful pregnancy, I did great and none of my tests and exams showed anything wrong at all. Then came the birth itself and my son started going into distress, I developed a fever and high blood pressure, and my midwives had to get the hospital OB to take over.

It can happen in an instant, with absolutely no warning. Childbirth may be “natural,” but it’s also the leading cause of death in women in their reproductive years. I don’t think we can say the same for bowel movements…

It cost me over $4,000 to have my child and that doesn’t include the NICU stay ($80,000 for 4 weeks, my baby is fine, thank you for asking =)).

There are many reasons why women do not want to give birth in a hospital and it’s not because of the lack of birthing suites. Much of it has to do with common procedures that have little evidence to back up their use (continuous fetal monitoring, pitocin given AFTER birth, being told when to push, having you lay on your back to push, not being allowed to labor for more than 24 hours and often much less time that, the prohibition of eating or drinking [my hospital allowed me to drink and eat as long as it wasn’t ‘heavy’] during labor, vaginal exams [not necessary unless there is a problem]). Those are some of the issues off of the top of my head. Not to mention that many women do not have access to OBs that will NOT respect the women’s simple request to have a hands off birth or a c-section happy doctor.

Women want to birth at home because they feel that it’s the best place to give birth. It’s not about bragging rights, or getting some sort of ‘high-five’ from crunchy hippies. If OBs and hospitals would drop the strawmen about home-birth advocates, they would realize that it’s their policies that are driving women into their homes to give birth.

Now, I prefer to give birth in a hospital. My doctor respected my wishes. I was able to labor and give birth how I wanted but many women do not.

I think you’ve set up a straw man here, comparing birth in the hospital to giving “birth in the backyard birthing shack with a stick in my mouth.” There are lots of professional midwives and other birth attendants out there who can give you professional service at a home birth, and yes, even give you pain meds in your home.

Safety issue is the biggest, of course, and there have been several studies that show that home birth can be SAFER than hospital birth, with QUALIFIED ATTENDANTS. A 6-year study done in Texas (http://www.gentlebirth.org/format/myths.html#Studies) showed that doctors in hospitals delivered babies with a mortality rate at 5.7 per 1,000 births, which is about the national average. Certified Nurse Midwives delivered babies with a mortality rate at 1.0 per 1,000, which is about one-sixth of the doctors’ rate. Non-nurse midwives still delivered at 1.9 deaths per 1,000, and “others” delivered with a mortality of 10.2 per 1,000, which is much worse than the doctors. So, with the properly qualified attendant, it is actually SAFER to have your baby at home. This is likely due to the facts alluded to in the OP, that the U.S. has a high caesarian rate; too much intervention can be a bad thing. Those European countries that have lower infant mortality than the U.S. AND fewer c-sections, by the way, use more midwives than obstetricians.

And I think it is a cultural issue that leads doctors to intervene more here in the U.S. Obstetricians are surgeons, and they think of the baby as something it is their job to remove from you, like a parasite. But there is no need to medicalize the whole issue as we do today in the U.S. I know I am talking in opposition to BITINGLY SARCASTIC article from the Skeptical O.B. that Skepchick recently linked to, about “medicalizing the tooth experience.” (http://skepticalob.blogspot.com/2011/04/dentists-medicalizing-tooth-experience.html) But think of it this way: for both your teeth and your baby, you go to the doctor regularly to make sure you’re staying healthy; for both your teeth and your baby, you go to the doctor when something is amiss; but when your juvenile tooth comes out as your expected, you stay home (unless something goes wrong), but when your baby comes out, you panic and run to the hospital, even if everything is proceeding as planned. I know there are some places where the analogy breaks down, such as the risks involved in tooth removal and the risks involved in childbirth. But, as the OP pointed out, hospitals are scary places, and that fear might not be founded in real dangers. And less fear means a better experience for our new mothers during a special moment in their lives.

Jeff, based on what Susannah said, those statistics sound skewed to me. The lower mortality rate for home births with qualified attendants is likely due to the fact that the mothers-to-be are vetted by the midwives, and those who are considered high-risk are told that a hospital would be better.

Oh, “Deliver Me From Pain” by Jacqueline H Wolf is EXCELLENT!! It’s the history of OB practices starting from the mid-1800’s (when they were just docs, not OBs)up to the present. It focuses on the evolution of pain management which drives the ‘progress’ of birth.

Home birth is ludicrous. Here’s why. You can’t predict a cord accident. You can’t. A perfectly normal “low-risk” pregnancy can end with a cord accident. So the baby’s vitals must be monitored continuously. Once a cord accident happens, you have 8 minutes before you have a blue, brain-damaged baby. Any obstacles that you put in the way of having a surgeon there to cut the adorable little bastard out endangers the pregnancy unnecessarily.

You are going to get a lot of woo-baggers proclaiming that the outcomes for home births are better than hospital outcomes, and they’re right. BAD OUTCOMES, INCLUDING BAD HOME BIRTHS, END UP AT THE HOSPITAL, so of course the data sets they cite are skewed. I’m all for an attempt at natural childbirth if a woman wants it. Midwives, nurse practitioners, and even fucking circus clowns should be available in the birthing suite if the patient wants it. But there needs to be a monitoring and a surgeon on hand in no more than 5-minutes. If you can meet those requirements, you can have the baby on the roof, for all I care.

Quantitative studies of medical outcomes began in obstetrics. At my old blog, the only time I shut down comment was from the homebirthing cultists. I pity you for wading into this, but it is an important medical topic that the Skepchicks should consider seriously.

Seriously, I don’t even get the desire for home birth. Do I want my sheets and rugs bloodied and mucousy? And (more importantly) do I want proper medical care a potentially fatal 20-minute drive away? I had 2 live vaginal hospital births, and I don’t get the big deal. I had no doula, or birth plan (unless you call “Rid me of this excruciating pain. Oh, and deliver healthy baby,” a birth plan) and the doctors did what they had to do to ensure me and my babies were healthy. People place such an emphasis on labor, and yes, it is scary and eye-poppingly painful, but in 24 hours or less (or thereabouts) it is all over and frankly, the scariest part when you think about it is that you/your partner are going home with sole responsibility for feeding, clothing, and parenting this tiny, helpless individual. Also, labor is by far not the only part of it that’s painful. Pregnancy isn’t so hot either, and the cracked and bleeding nipples and engorgement that come with breastfeeding plus all the funny stuff going on “down there” once the labor is over deserve their own circles in childbearing hell. Labor is just an excruciating introduction to the lifelong sacrifice and difficulties that are only just beginning. And man, is it ever worth it.

I also highly recommend reading Dr Amy Tutueur’s blog (skepticalob.blogspot.com). She doesn’t always subscribe to the ‘don’t be a dick’ rule of thumb, but I find her input into the discussion very valuable as an antidote to all the anti-science promoted by the natural/homebirth crowd.

I’m in the same position as you Evelyn, in considering having children sometime in the next few years, and there is no way I’d consider a homebirth. I’d much rather take advantage of all that modern medical science has to offer, and have a better chance of getting a live healthy baby at the end of it. The ‘experience’ of childbirth concerns me a lot less than the outcome of the health of my future children.

I have followed the home birth issue for some time now, and after reading some of the post here I think that there are some things that need clarifying. There is a lot I would like to write about, but for now I just want to address the issue “are home birth are illegal in the United States?”–which sexycelticlady mentioned. The answer is no. There is no state in which home births are illegal–nor has there ever been. There is an obvious reason as to why this is the case. When doing research on home birth the first thing a person will notice is that there are many home births that are completely unintentional. It would be a ridiculous legal mess for any state to outlaw home births flat out; it would require a huge waste of tax payer money and a complete stripping of our civil liberties to require prosecutors and police to investigate each and every home birth to see if it was planned or not–something that nobody wants. What is outlawed in some states–each state has different laws in this regard–are planned home births overseen by a certified professional midwife (CPN)–or rather, many states only allow certified nurse midwife (CNM) and OBGYNs to perform home births. Where I live in Illinois, for example, is one such state. Essentially, it is considered that CPNs are not real healthcare providers. They do not have adequate medical training or knowledge to give appropriate medical advice. They should not be allowed to do home births in the same way some states do not give licenses to naturopaths. (In Illinois naturopathic licenses also doesn’t exist.) For them to do so is basically practicing medicine without a license.

On a personal note, I strongly agree with this position. It is my experience that many CPNs, both by meeting them directly and reading their literature, are not interested in science based medicine. What they are interested in is certain traditions of midwifery. Some times that aligns with the science, but many times it doesn’t. Of course many OBGYNs and CNMs are reluctant to do home births. I think it is important to note that OBGYNs much more so than CNMs. This is mostly a cultural difference in part relating to their two different traditions, and historical conflicts between the to practices. It has a real interesting history which you can learn about from this great episode of Skeptically Speaking: http://skepticallyspeaking.ca/episodes/110-a-history-of-childbirth Either way though, the reluctance from the medical community has essentially meant that there is a quiet de facto ban on home births in the United States. Despite the heated debates, home births still only make up 1-2% of total births in the United States.
Many home birth advocates have realized that the only way to get around this de facto ban is to loosen medical regulations so that CPNs are legally allowed to perform home births. Most of their activism is focused on this issue.

Riki Lake has often made comments on comparing loosing the restrictions on home births to the legalizing of abortion. She says she is pro-choice, and that all she wants to do is provide people with options. Intellectually, I provide this argument to quite dubious–and as someone who works at an abortion clinic in Chicago, I find it a little offensive. It is dubious because as I stated early home births have never been illegal in the United States. It is only illegal for people who do not have proper medical training to give people medical advice and perform them. And again, each state is different in this regard. Some states do allow CPNs to perform home births–just as some states license acupuncturist to treat cancer. Abortion on the other hand used to be illegal in every single state in the United States. Also, the pro-choice (regarding abortion) movement has never advocated that non-medical professionals should perform abortions. The whole point of legalizing abortion was to make it so that medical professions could perform abortions women, and doing so made it easier and safer for women. I find those comments offensive because it seems to imply that people in the home birth movement (or depending on how you look at it, the loosening of medical licenses movement) experience a similar marginalization and threats that people who perform abortions do. That is just not the case. CPNs do not get people regularly protesting their offices, or have packages with a dead animals left at their front doors–both of which happen at my work. Making such a comparison just seems like a cheap way to milk people’s sympathies for one cause in the hope that you can apply it to another without anyone really noticing the differences between the two.

There is also the issue of the science regarding home birth safety. I have read some on this–and though I am willing to admit it is mixed in many areas–I think it does fall more to the conclusion that hospital births are safer for the new born child. But, I am no expert on the matter. I would like to go more into the details of what I have read, but to be perfectly frank–I’m really tired, and have to get up early tomorrow to go to work. Anyway, I’m sure the discussion will continue.

Correction – I actually said home birth in the presence of a professional midwife, which you confirmed is illegal in some states, not the birth itself but the option to employ a midwife. In the US is midwifery not a medical qualification? This may be my ignorance, in the UK you have to have specific medical qualifications before you can work as a midwife.

Midwifery is of course legal and a recognized medical profession her in the United States–but there are two types of midwives–certified nurse midwives (CNM), which are legally licensed in every state, and certified professional midwives (CPM) only legal in a few states. I do think that being a CNM is a profession that is widely respected here in the United States, though should probably be more so. CPMs are much less so, and personally I think there are grounds for this, along with refusing to license the whole practice of CPM altogether. You can find the difference between the two in the terms of credentials here: http://cfmidwifery.org/midwifery/faq.aspx#5 First, CPM are not trained in general nursing–they merely focus on “direct entry deliveries” –meaning home births. Second, you do not have to have completed a bachelors degree to become one. What that means is no basic science classes. Third, the accreditation for programs is approved by the Midwifery Education Accreditation Council (MEAC). If you go their website (here: http://www.meacschools.org/)you will find really blatant misuse of studies. For example they cite one study entitled the “Milbank Report Reveals Serious Problems in Maternity Care Quality and Value” for making an argument for home births. But, if you actually read the study, which can be found here: http://www.milbank.org/reports/0809MaternityCare/0809MaternityCare.html you find that no where in the report’s policy recommendations you will find that home births are not advocated for. The closest thing they come to his advocating that all licensed midwives–CPMs and CNMs–are eligible for medicaid reimbursement. Mostly what the reports advocates for is increasing evidenced based approaches in all aspects of the maternity process. Nevertheless, MEAC uses this report to make a case for home births.

For these reasons and more I think that the licensing of CPMs is not beneficial to patients can do seriously harm. If a person is seriously interested in becoming a midwife in the United States then I think that person should go through the process and requirements established for CNMs.

Just because someone says they are a “professional” or even claim to have a “doctorate” does not mean that they should be given the same respect and authority as others. As I stated early, I think it is clear that the main goal of CPMs is to advance a particular brand of midwifery–there is little concern to practice science based medicine, or ensure what is best for the mother and child. Many claim that OBGYNs are unfairly biased against home births, but the argument is tough to take seriously when it comes from CPMs. The are clearly, and quite openly, biased in favor of them–without providing much evidence as to why they are so superior to hospital births. The the Midwives Alliance of North America–their main organization of CPMs–has on its website a list of studies on home births. None of them call in to question the practice. If anyone does research on this issue you will find right away that the literature on this topic is much more mixed–to say the least–then what NAMA presents. Also, you will find many of the reports they cite are quite old–the most recent one being around 15 years ago. Noticeably missing is a meta analysis done by the American Journal of Obstetrics and Gynecology: Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis, by Wax et al. (Here: http://www.ncbi.nlm.nih.gov/pubmed/20598284 for Harriet Hall’s comments on the report on sciencebasedmedicine.org go here: http://www.sciencebasedmedicine.org/?p=6274) This report concluded that the neonatal death was twice as likely overall with home births and three times as likely for non-anomalous births. Even though some claim that this report was unfair, it is important to note that they also found that women who planned their home births had fewer infections and other problems. If the report is so biased, like some CPMs and home birth advocates claim, why these nuanced conclusions? Also is missing is the recent report which found the Netherlands–often held-up as the maternity model which the United States should aspire to become–has one of the highest neonatal death rates in Europe. (Here: http://www.ncbi.nlm.nih.gov/pubmed/19192585)

If people are going to practice medicine, then we have to recognize that practitioners will be placed in a position of authority. We need to have constraints to ensure that authority isn’t abused. The loosening of medical licenses in the United States with not only CPMs but pretty much all practitioners of CAM advocate for really is a subtle attack on patient’s rights. Under the guise of “health freedom”, or “pro-choice” in the home birth movement, we are seeing a subtle attack on patient’s rights. Consent only matters if it is informed, and if our medical professionals are misinforming people about the consequences of their decision then people can’t exercise true consent.

If a women wants to have a home birth, is aware of the possible problems with it, and can find a healthcare professional (either CNM or OBGYN) to help her–I don’t think she should be prevented for doing so. However, to license CPMs is to just ask for trouble. All this does is provide opportunities for patients to be misled into believing they are receiving top notch care when actually they are not.

This thread has been a very interesting read. However, personally, when I compare the dangers of home births with the dangers of hospital births… I will pick hospital births every time. Home birth dangers mean potential death and serious damage… hospital birth dangers mean a violation of my personal space and comfort. No, I don’t mean how pretty the birthing room is… I mean hospital birth dangers include doctors and nurses doing things to my body that I don’t agree with… but that don’t endanger my child or myself in any meaningful way. Cord around baby’s neck? Yeah… that’s a danger in a meaningful way. Pitocin when I’d rather my body just take care of things on its own? Not a danger to anything but my personal ideas of how my birth should go.

Yes, I know that studies show most births go smoothly and really don’t need all those precautions, and therefore, a home birth is perfectly safe. But, I’m a “better safe than sorry” kind of gal. My birth will be in a hospital with all the experts close at hand in case the worst does happen, and by God, I will have drugs. One of my best friends has a PhD in Medicine and she said it best “Why do I want to mar one of the best times of my life with blinding pain? Why not enjoy myself and forgo all that screaming and poo until AFTER the birth?” Why indeed, I say.

(As a side note, I don’t assert that my opinion should be the opinion of all. I have friends on both sides of the birthing room, and I don’t assume to know what drives any of them. All I know is what I’m comfortable with.)

Maybe I missed it in the comments but you do know it’s not an either or proposition right? It isn’t hospital or home with nothing in between. There are more and more birthing centers being opened which are more homelike in feel but have full staffs of nurse midwives, doulas, and OBs and they are usually located near a hospital with admitting privileges in case of complications. The idea is to have a more comfortable homelike environment for the birth but still have the medical benefits of a hospital birth.

I have no intention of ever having children (I learned all this when my cousin was pregnant and talking about it constantly) but if I was that is definitely the route I would go.

I gave birth six months ago. I had a “low-risk” pregnancy for 9 months, and was only 2 days past my due date when my Ob-Gyn suggested we induce labor — the kind of medical intervention many home birth advocates deprecate. But ultrasounds were showing a very large baby in there. My water was broken manually. Also deprecated. The purpose of that maneuver is to speed up labor. Despite the comments above, longer labors increase the risks of oxygen deprivation to the baby. In my case, though, breaking the water also revealed significant amounts of meconium, which meant I suddenly became very high risk indeed. Meconium, like a cord prolapse, can’t be predicted in advance. As soon as my baby’s head was out, they were suctioning her lungs. She was on oxygen, with IVs, within minutes after that. Had we been at home, she might well have died. As it was, after three days in the “special care” nursery and a $14,000 hospital bill ($8k paid by insurance, $6k by us) she came home healthy and happy. I might try to skip the epidural next time — I pretty much hated the epidural, though I don’t know how much I would’ve hated the pain it spared me — but I would not ever have a baby without aspirators and oxygen hoods and IVs available in the room, and, as mentioned above, a surgeon on hand. You can be “low risk” relative to other pregancies, but pregnancy is inherently a high risk situation. (If you’re impressed by Eval Knieval, you ought to be even more impressed by the average mom.) It’s the price of walking upright, I guess. When I think about what could’ve happened to my daughter if we’d’ve lived at a time or in a place when home births were the only option, I am very glad I live when and where I do. I’ll take an over-medicalized birth experience over a dead baby any day.

My labour was very similar to yours mks.mary. I had the golden archetype of what a pregnancy should be if all is going well. My labour started on its own about 10 days after my due date and everything was going swimmingly as we made our way to the hospital and installed ourselves in our delivery room.

Then, things started going wrong. I don’t know what the might-have-beens are, but it seemed like just about everything stopped working. There was a great deal of meconium when my water broke, my blood pressure was getting dangerously high, my son’s heart rate kept dipping and they were worried that he might be going into distress, my own heart wasn’t beating right, I developed a fever, the labour just kept going and going and going…

I did have an epidural, which bought me a couple of hours of rest before the actual pushing phase started (we turned it down for that part so that I could feel what I was doing). I was in active labour for almost 24 hours and I’m not sure that I would have made it without the rest that “medicalized birth” gave me.

Turns out that my son was big, very big. And because he was so big, his glucose levels kept crashing. He probably would have survived this without the hospital monitoring because he kept going back up into “not about to seizure” levels whenever I breastfed him, but the monitoring certainly helped to my our minds at ease.

And then, after a day, I got to go home with my happy healthy son and that was the end of it.

I agree with the commenter who said that the dangers of a hospital birth are nothing compared to the dangers of a home birth. Yes, you’ll probably suffer some indignities, but there is very little about giving birth that’s dignified anyway. In the end, the only thing that matters is that you, and your baby, survive.

Howdy when I had my baby some 3 and a half years ago now I did a lot of thinking about how and where to have my baby. I live in the UK.

I decided hospital was the best place. I did consider home birth but 1) I live some distance from a hospital and on the worst congested road ever so help would take some time to arrive 2) I had visions of the dog getting in on the act and running off with the after birth.

I did my research and formulated my birth plan which I have put here. My Midwife actually complemented me on it.

Birth Plan

Dear doctors, paediatricians and midwives who may be attendant at delivery.

Please find below the request of my husband and I for labour, delivery and after-care. My husband and I are keen to have as little medical intervention as possible during labour and delivery and the opportunity to bond and nurse my baby immediately after birth with minimal interruption. I wish to leave hospital as soon as I am deemed fit to do so. I will trust your medical judgement and feel confident you will support my request as long as they are medically feasible.

1) Should my baby be overdue I do not wish to be induced unless it is deemed medically necessary. If considered necessary full reasons given and time to discuss with partner before any decision is made. This includes membrane sweeps.
2) I wish my husband to be present at birth and attended during birth by midwives only.
3) I am happy to allow student to be present at the birth as long as their numbers are low. Though I reserve the right to ask them to leave if for any reason If I feel uncomfortable.
4) During labour and delivery I would like to be able to move about freely and find position most comfortable for myself with no restrictive monitoring of the baby or myself.
5) For pain relief I wish to have gas and air as my main source. I am willing to consider other forms of pain relief only if it is obvious that the pain is causing me excessive problems.
6) On delivery of my baby I would like it to be handed to me immediately so I can attempt to nurse the baby. I DO NOT WANT THE SEX OF THE BABY ANNOUCED I WISH TO FIND OUT FOR MYSELF PLEASE. Also in the third stage allow the cord to cease pulsing before it is clamped and cut.
7) I would prefer the perineum to tear naturally and intervention not to be used to assist delivery unless it is deemed absolutely medically necessary. If you think it should be done full reasons given and uninterrupted time to discuss with my husband if there is no immediate danger to the baby.

In the event of complications during labour and delivery:

1) If I should have to have a caesarean birth, to have my husband present holding my hand
2) In the event of the baby needing special care, To be able to hold the baby if medically feasible or at least touch him/her before he/she goes to the SCBU or for treatment.

Signed: J and D

Signed: Midwife/Doctor ( I have read the above and respect the parents views )

Thankfully it was pretty much a text book birth, I did have my waters broken for me as it was holding up the process due to it having a tough membrane. I also had a water birth which was nice really took the weight off and If I have more children I’d do that again. The water pool room did have a hospital room feel to it but when you are forcing something large out of a little hole you really don’t care about such things.

Gas and Air was fun I can dimly recall chilling in the water spacing out, well that is until the full force of contractions kicked in. I opted for just gas and air as the effects are short lived and would allow me to go home with the most amazing thing ever the same night which I did.

I have been present at the births of my 4 children in hospitals. I have also gone through home birth preparation by a qualified midwife. Here is what I know:

Nurses in Labor & Delivery are not required to have midwife training. ObGyn physicians are driven by insurer reimbursement policies to provide care contrary to common sense. The rules for operating labor and delivery are set by risk assessment auditors, not medical professionals. As a consequence, it takes skill and chutzpah to avoid bad care during this perfectly natural part of life.

When my wife had our first baby, the nurse said she was not in active labor. Best thing ever, as we were left alone in labor until the actual pushing started. At which point the only doctor available, a cardiologist, rushed in to complete the delivery.

With the next child, the Lamaze classes at the hospital involved telling all couples to have epidurals. We filed a birthing plan in the chart, and the attending physician refused to participate in the delivery. I have no idea who the delivering physician was; he just stepped in from the hall at the crucial moment. Nothing in that giant hospital was organized toward providing good birthing care; it was designed for maximizing profits instead.

After this, we got training in birthing from a midwife. With child 4, I insisted that the infant stay in the room and not go to the nursery. (Actually, this is easy if you refuse to allow the baby to be bathed.) I demanded that the nursing staff complete all examination of the baby in 30 minutes, so that the baby could nurse and then sleep. The doctor agreed, but said that she could not influence hospital procedures. So I said, “Tell them that the father is a raving ass, and if they fail to do this they are guaranteed to have the worst day of their professional lives.” Well, that worked a charm.

Skepchick, I suggest reading articles on birth from the archives of Scientific American, and also take a home birthing class from a qualified midwife. It would be most enlightening.

All the handwaving about the medicalized experience seems a little silly to me as someone who had difficulty getting pregnant in the first place and then suffered two miscarriages. I’ll do whatever it takes to birth live, healthy, full-term babies. If it turns out that some intervention was unnecessary in hindsight, I don’t care. I’d rather err on the side of caution.

That said, I appreciate the fact that my hospital births were as comfortable, relaxed and calm, as possible under the circumstances.

I think the social shaming surrounding childbirth is really unfortunate.

My wonderful healthy 17 year old daughter is graduating from high school next month and will be playing a solo at the next concert of our local youth symphony. Had her birth, which was anticipated to be completely normal, been at home it is very likely she would have suffered significant brain damage or death. I can not imagine having potentially necessary interventions an ambulance ride away.

OK. Logged in to comment, and if this has already been said, my apologies ( I have not finished reading ALL the comments).

Home birth is generally safe for low risk women. In the US, the risk of fetal/newborn death is statistically higher in home births than hospital births. Why? No one is quite sure.

However, there is a false scenario above. While cord prolapse IS a major danger to the baby, and IN A LARGE hospital, you can have a c/section within a few minutes, in many small county hospitals, you’d be lucky to get the baby out within the 30 minutes recommended by ACOG. Not all hospitals have anesthesiologists on 24/7 in house call, and not all have the OR staff availiable (or the L&D staff trained) to handle a stat C/section. And, yes, I HAVE worked in hospitals like that. Can you transport a mother from home to the hospital in the same time? Again, depends on where you live in the US.

Compare this to some countries like The Netherlands where home births are more common, transport is at hand, and healthcare is covered for all. Homebirths, for both mother and child, are much safer. They are attended by trained physicians and/or midwives.

Here in the US, home births may be attended by (rarely) physicians, (sometimes) nurse-midwives, (occasionally) lay (non medically trained) midwives, or even totally unattended. So yes, in the USA fetal/newborn death with a home birth is much more common. (Along with the fact that in the USA ANY live birth, no matter what weight, size, or gestation is considered a live birth, which puts the US statistics for fetal/neonatal death at variance with most other first-world countries)

Not all women are candidates for home birth. Not all women who WANT home births should have them. Not all home births are safe. For some women, hospital births are safer. Or birth centers may be safer for those who don’t want a hospital birth but yet don’t want to deal with a home birth. For those women who truly qualify for home birth, and want a home birth attended by an intelligent, trained, licensed care giver, home birth is probably safe.

Is there still a higher fetal/neonatal risk? Perhaps. But it’s truly hard to determine. You can’t compare hospital births to home births unless you completely match the populations by age, health factors, pregnancy risks, non-use of pain medications (most home birth midwives do not carry any pain meds), etc. I don’t think there is a single study (at least, not that I have seen, even listed on SBM or by Dr Tuteur) that completely matches populations.

Disclaimer: I am a CNM, no longer practicing. I did not attend home births but had many CNM friends who did/do. I worked in a birth center, in a hospital, and as an observer went to some home births. I have no dog in this fight.

I am always so suprised to realize that I am NOT every-woman- that we all really and truly have such a unique and individual experience on this planet-
I believe that I am the only person responding so far who has actually had a homebirth. Two, in fact. My first child was born in the hospital. My labor progressed very quickly after I was admitted. My daughter was born “naturally” and was very healthy. My second child was born at home with trained midwives as was my third. Both very healthy boys. My labors were all considered fast – increasingly so. My third labor was so fast that from the onset of active labor to the delivery of my placenta was merely 45 minutes. My son would have been delivered at home regardless of what my plans were.
I can not believe that anyone who has ever harbored a child in their womb would make a choice about their baby’s birth that they did not believe to be in the best interest of that child. That said, we need to be informed about childbirth as a natural progression of life. We need to hear the positive stories and understand the risks of our individual situations and histories. Most importantly we need to feel safe and respected in our choices. In the hospital or at home. We need to have the legislation to back up midwifery so that it is a safe and respectable practice- most states are not doing this.
I feel that I made the right choice for each of my children
but I am not going to make the same choice for anyone else – I am not every woman, and neither are you. Stay informed about the resources that you have available.
I am admittedly not at my best- it is late and i just really wanted to respond while I had a moment- I would happily talk in more depth about my perspective if anyone is interested- but, hence, for now, my little heathens will awaken before I know it:)

I used to be ambivalent about home vs hospital births. I lived in the Netherlands for a few years, where home births are fairly normal. That was until I was pregnant. Once I got past the first few months, I wanted more than anything to have a healthy baby at the end. While most home births go well in healthy pregnancies, there are a few conditions, such as placental abruption and umbilical cord prolapse, in which an emergency c-section is necessary to avoid infant death, or serious injury/permanent brain damage etc. I think the risk of neonatal death is around 0.5% overall, and 1 – 1.5% for home birth, because it has two to three times higher risk of death. So there is a risk of 0.5 to 1% that the decision to go with a home birth has killed the baby. For me, that risk was too high once I was pregnant.
I have to say that I had a nice experience in the hospital. I had my own labour and delivery room. The nurses were kind “would you like an epidural, Sweetie?”. I could bring my own things from home if I wanted (not sure if candles would have been OK due to fire risk, but pot pourri – sure!). My CNM and OBGYN who were with me during my prenatal visits was there during labor and delivered my baby. I breastfed within half an hour of the birth, and my little girl was in my room the whole time I was there. So hosptial births can be pleasant, too.

My sister has two children. Having done a lot of research, she decided to have a home birth on her first. She got in touch with a professional midwife who does home births. This midwife attended her all through the pregnancy and when the time came, came over to the house. Shortly after my sister’s waters broke, the midwife determined that there was meconium in the waters and called an ambulance to bring her to hospital. Meconium in the waters isn’t a sure sign that something is wrong (and, thankfully, in this case, nothing was), but it raises a warning flag. She had her first child in hospital. Two years later she had her second child at home. She said that the two could not be compared and that the home birth was better by far in many ways.

When people talk about giving birth at home being more natural, they’re not talking about natural in a ‘rubbing plants on yourself instead of taking medicine’ sort of a way. They mean that when you give birth in a hospital your birth experience is filled with people interfering needlessly. I’m not as clear from on what hospital births are like in the States. But I know from my own experience that maternity hospitals here are run like factories. You have so long to go through this stage, so long to go through that stage and so on. If you’re not keeping to their timetable you will be ‘helped along’. This isn’t for any benefit of the mother or baby. It’s because they have to keep everyone moving along or they won’t be able to deal with everyone coming in.

I agree that just deciding to not go to hospital is a foolish and potentially dangerous idea. Your ‘and maybe a midwife’ statement above implies that that’s what you think of when you hear about home births. But that’s not what home birth is. It is, to my eyes, essential that you have someone there who knows what things are potential problems that do need medical attention. It is very rare for problems in birth to happen suddenly and without warning signs. You just need to make sure you have someone there who knows them and will send you to hospital if they show up.

I had my son in hospital. I was induced, probably needlessly, because he was ‘overdue’. There is a required stay of a few days in hospital. That was really unpleasant. We were being visited by various health professionals until 11pm and woken at 6am for breakfast. We were not allowed to make our own choice as to whether to sleep with the baby in the bed with us or not (like most people in our culture who haven’t actually researched it, whoever is in charge of hospital policy on the matter is of the mistaken opinion that it’s unsafe). We could not have the baby’s father there with us to help overnight. I had decided to breastfeed and had to repeatedly turn down offers of bottles for the baby. My sister had been able to go home from hospital the same day she gave birth because she had her midwife there to look after her and the baby. Since my son was born very shortly after her daughter, her midwife offered to look after us as well and I was able to go home a day early, for which I am still extremely grateful. Next time, I’m having a home birth.

I would find it foolish to not go to the hospital. They do have life saving procedures. I agree there are lots of procedures, some pretty invasive. I would rather have the opportunity to make an informed decision (know all options available) and choose not to have a procedure, rather than throw all caution to the wind.

With that said, there is something wrong with the health care system. It is a business and it runs on profits. They are selling procedures and talking with you means time that is not making the hospital money. That does not mean that I would give health care system the bird. It just means I need to understand the animal and do everything that I can to make an informed decisions.

I would find it foolish to not go to hospital if the doctor I’d been seeing all through my pregnancy, or the midwife at my birth, thought I was in any way likely to urgently need one of those procedures. But if I have a doctor and a midwife that I trust and I believe to be medically competent to do their jobs, I don’t see why I should go to hospital unless they say I should. Do you only cross the street in hospital? What about all the other potentially hazardous things you do?